NOTEWORTHY REFERENCES

NOTEWORTHY REFERENCES

“STORINGOR SUPPLIES: SHOULD IT BE THE NURSES’ HEADACHE?”Katz, Esther, RN: Medical-Surgical Review, February 1970. If nursing in the surgical suite is nursing, then nurses must eliminate nonnursing functions from their daily routines, and concentrate on patient care. The routine care and storing of supplies are among these nonnursing duties. With careful planning and cooperation, a system which will work for every surgical suite can be developed and implemented. OR nurses shouldn’t be concerned with the washing, wrapping and sterilizing of instruments and supplies when nurses in general are concentrating on patient care. Nurses involved in patient care consider central supply technicians thoroughly prepared to proces all material needed in the clinical area. It is time to break with tradition and realize that in many hospitals today, there are no storage areas in or near the surgical suite. If the OR nurse is really a specialist, should she be spending her time searching for material, maintaining inventories, sterilizing supplies? Of course not! Any function not directly concerned with patient care does not fully utilize the OR nurse’s talents. With few exceptions, surgical procedures are scheduled at least one or two days ahead. This gives time for the nurse responsible for the nursing care plan to requestion all the

July 1970

needed instruments and supplies. She can refer to the surgeon’s preference card and specify any needed extras. The evening before surgery, central supply personnel load small carts for the individual procedures and deliver them to the suite. Following surgery, all material (excluding linen) is placed in plastic-lined tote boxes and returned to the central supply department for decontamination and processing for re-use. Procedures other than those scheduled are also supplied through central supply, which has several carts standing by at all times for emergencies. Standardization of basic instrument trays and supplies provides an efficient means of handling the unexpected. Processing all equipment through central supply, produces such advantages as the prevention of outdated or obsolete materials accumulating on the shelves, and ease of converting to new products and maintaining inventories. Time saved can be used for pre arid postoperative visits to surgical patients. SR.DOLORES KANE,RHSJ, RN Chicago, I11 “TREND-SETTING OR OF THE FUTURE BEING BUILT TODAY” Hicks, Allen M.; Beck, Rita Mary, RN, BSN: Modern Hospital, 114:1, 9599, 1970.

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Unified care for the surgical patient, from hospital admission to discharge, is the goal of the new surgical complex being constructed at Illinois Masonic Medical Center in Chicago. This OR of tomorrow will incorporate many unique ideas and concepts into its structure, The surgical complex, which has received a demonstration grant from HEW, will consist of four major elements: 1 ) preoperative beds, all in single rooms; 2 ) the surgical suite, including operating rooms, clean work core, patient ring corridor, surgical team facilities, and supply and waste systems; 3 ) a recovery room; and 4) a surgical intensive care unit. The entire complex is administered by the director of surgical services. Preoperative patients will be admitted directly to preop beds, rather than “house” beds, and transferred to the surgery unit through the “front” OR door via sling stretchers. OR staff will change and shower on the floor above the OR, and enter through the OR “back” door. The clean core area will be surrounded by OR suites. High speed instrument sterilizers and decontaminating devices will eliminate instruments being sent to central supply. Passthrough cases will deliver supplies to rooms. Unique floor pedestals will eliminate cords and hoses and will contain noninflammable gases, monitoring devices, remote controlled cautery, water, compressed air, and possibly defibrillator leads. Suites will be supplied with a 100% fresh air supply exhaust system, and vertical lifts will be part of the clean goods delivery system, with a minimum of handling, protect. ing asepsis. Color-coded waste bags, on conveyor belts, will be electronically sorted for proper destination to either central sterile, laundry or incinerator.

A communications network composed of interdepartmental intercom, TV, and pneumatic tube system will link OR personnel with pathology, radiology, pharmacy and patient

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families in adjoining family waiting rooms. Recovery rooms will feature an air-strip-flow barrier between beds, and pneumatic seals in ICU will provide air and sound control. Both of these will inhibit cross contamination.

MURIELT. HANEWINCKEL, RN Denver, Colo

“LOOKING AROUND-THREAT, CHALLENGE, OPPORTUNITY OR FIZZLE?” Modern Hospital 113:6, 93 December 1969. Profit-making corporations are buying, building, leasing and managing hospitals. Will this continue? Will they become a challenge to nonprofit hospitals? This article discusses the pros and cons of profit-making hospitals. Some people see these hospitals (run by corporations) as threats to the well-established method of providing hospital services for the population. Others see them as challenges for existing hospital establishments to prove they can do the job better. Others see the corporation hospitals as opportunities, and have joined the corporate staffs. Problems will come if corporations are allowed to build hospitals wherever they want to in addition to just where they are needed. Also, a problem could arise if these hospitals deal only in money-making services and leave the burden of obstetric, pediatric, emergency, outpatient and welfare cases to pile up in nonprofit and public hospitals. This threat from corporations could benefit existing nonprofit hospitals if, from it, they learn to initiate mergers, joint ventures, shared services and pooled operations. These could achieve economies and efficiencies beyond the reach of individual, autonomous, disjunctive units.

MABELCHAWFORD, RN Los Angeles, Calif

AORN Journal

side of the bed where she can control the “THE LATERALPOSITION IN CATHETERIZAClinics of patient without interfering with the work

TION” Roman, Lorraine: Nursing

North America, pp 189-190,March 1970. Traditionally, the female patient is catheterized in the dorsal recumbent position, in spite of this position having many disadvantages Among these disadvantages are the maintaining of sterile technique and the emotional and physical discomfort to the patient. The author suggests having the patient assume a lateral position with the knees drawn toward the chest. This position proves more comfortable and reassuring to the patient, permits less danger of break in technique and makes the procedure easier for the nurse. If the nurse is righthanded, the patient should lie on her left side. The nurse stands so that her right hand is closest to the foot of the bed, where her equipment is placed. The patient’s buttocks should be close to the edge of the bed beside which the nurse is standing, and her shoulders should be closer to the other side of the bed. With the patient in this position, the nurse need only lift up the right labrum for the urethral orifice to be clearly visible. The position, as described, should be reversed for the nurse who is left handed. Advantages of the position include : 1. The patient is more physically comfortable. 2. There is less embarrassment for the patient. 3. Anxiety is lessened when the patient does not see the equipment. 4. The nurse has a larger field in which to work, and she can maintain better body mechanics with the patient in this position. 5. Since the urethral orifice is more visible, the danger of contamination is lessened. 6. Since the patient is more comfortable, she is also more relaxed and the catheter can be more easily inserted. 7. Should another person be needed to help hold the patient, she can stand at the other

July 1970

area.

SR.DOLORES KANE,RHSJ, RN Chicago, I11 “WILL YOURNEXTDOCTORBE A DOCTOR?” Michaelson, Mike: Today’s Health, pp 37-41, March 1970. A new concept of practicing medicine is under way and is already proving itself a boon to isolated communities throughout the country. Backed by local medical societies, medical schools and physicians, this new idea is bringing better health care to areas unable to attract the services of a practicing physician. After an intensive six-month training program at the University of New Mexico School of Medicine, a Registered Nurse in rural areas outside Albuquerque is able to conduct a clinic to extend medical care to patients who otherwise might never see a doctor. Her chief functions are to observe and describe illness, to discern normal from abnormal, and report her abnormal findings to two physicians. She may elect to treat the patient on the spot, with or without telephone consultation with a physician; ask the patient to return to the clinic when one of the MDs will be present; or send the patient into Albuquerque for immediate examination by a physician. The Medex program for exmilitary corpsmen, developed cooperatively with the Washington State Medical Society, is another innovation aimed at helping the overworked rural physician. Fifteen excorpsmen were chosen to launch the program last year. After a three month training program at the University of Washington, these men spent one year with a practicing physician. On completion of their on-the-job training, they were to be hired as physicians’ assistants at a starting salary of $8000-$12,000per year. After four months in the field, MDs are already enthusiastically predicting success for the program.

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Another unique project is under way in Lafayette County, Fla. A group of medical studenls and senior nursing students from the University of Florida J. Hollis Miller Health Center spend three weeks away from campus in the tiny community of Mayo. The clinic they staff serves a three-fold purpose: 1) teaching and training in community medicine for medical and nursing students; 2 ) furnishing medical service in a community where it was not previously available; and 3) supplying information for a critical study of the problems of providing health care for people. Under our present system of health care, there are simply not enough doctors available to deliver care to all people, and despite increased enrollment, medical schools will not be able to quickly improve the situation. Experts point out that systems of delivery of good health care must be restructured.

‘Thus the new health professional, in the form of a physician’s assistant, has come to the fore.

In addition, it should estimate benefits of health care recruitment competition. These may compensate for problems, and also enhance the hospital’s position as employer. There must be a definite statement of policy for both the part-time and full-time employee and these should of necessity suit the hospital’s individual needs.

MABELCRAWFORD, RN Los Angeles, Calif “DEVELOPINGMANAGEMENT’S COMMUNICATIONS SKILLS” Keefe, William : HospitaE Progress pp 65-68, February 1970. Most hospitals believe their communications programs answer the basic questions in employees’ minds concerning the hospital’s progress, future plans, policies and services. On the other hand, employees don’t feel this way.

A major goal of communication within an institution should be to enable each employee to associate his own success with that of his employer.

MURIELT. HANEWINCKEL, RN

Since meaningful communication is often the touch-stone of good management, the following specific purposes of a hospital communication program should be consid“GIVE PART-TIME EMPLOYEESFULL-TIME CONSIDERATION” Modern Hospital 114 :2, 70- ered : Denver, Colo

74, February 1970. Regular, part-time employees fill a vital need in hospitals. A fair wage and benefit policy for this group of workers should be established. Benefits for full and part-time employees should be based only on working time, with part-time employees determined by management of the hospital according to job and the area’s staffing needs. For administrative purposes, the hospital should set a minimum number of total weekly hours to be worked by part-time employees. It should also consider whether or not programs create excessive administrative problems or unreasonable costs.

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1. to transmit information of significance and interest to employees;

2. to influence the employee community to become “involved,” in order to make a better than average contribution; 3. to establish and maintain relationships and a general atmosphere which indicates managements’ concern for the employees’ best interests; and

4, to increase employees’ readiness accept, and even suggest, change.

to

The above goals constitute the general purposes of organizational communication. Management, however, must make its communication efforts broaden to include good listening.

AORN Journal

The listening required today has these distinguishing characteristics :

1. It seeks to learn, not to persuade. 2. It is action-oriented and results in constructive action, when feasible. When action is not feasible, double-talk, at least, is avoided and real reasons are given.

3. It ranges through an entire work force, including everyone from the lowest to the highest. 4. It looks for the real meanings which lie behind works.

5. It admits the possibility of change in the listener. 6. It dismisses nothing as “too trivial” or “unimportant,” because what is unimportant to one man may cause another to quit, or strike, or drag his feet,

7. The good listener does not give advice, avoids leading questions, refrains from making moral judgments about opinions expressed and avoids argument at all costs.

KANE,RHSJ, RN SR. DOLORES Chicago, I11 “PROFESSIONAL CLOSENESS”Peplau, Hildegard E.: Nursing Forum, 8:342-340,1969. As an essential element in nursing situations, professional closeness is focused exclusively on the interests, concerns, and needs of the patient. The nurse must detach her selfinterest from the patient situation so that she may act as stimulus to, and as an agent for, favorable change in the patient. The nurse is then able to add to her store of data from which universal human experiences can be abstracted and used to enrich her care of other patients. The patient also learns something important to him. The author distinguishes professional closeness from: 1) physical closeness, such as the intimate physical act of a mother securely holding her infant; 2) interpersonal intimacy, or “chum relationships” characterized by

July 1970

verbal exchanges of shared experiences; and 3) pseudo-closeness, in which clichb, reassurances and sympathy are used with others in order to evoke approval. Although aspects of all types of closeness may be present, it is the exclusive focus on the patient and his needs which make professional closeness unique and of most value to the patient himself. Nursing care occurs within an interpersonal relationship of nurse to patient, and is geared toward the ultimate goal of patient learning, as well as simple recovery from illness. The nurse conveys interest in patient expressiveness when she encourages him to respond to such questions as “What do you think?” ‘
BARBARA GRUENDEMANN, RN Encino, Calif

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